Communications: Patient Education

Patient Education: Prolonged Cough May Be More Than Just A Lingering Cold

Thursday, November 15, 2007  
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While many Minnesotans will simply write it off as a bad cold, a severe cough could be caused by something much more troublesome, especially to infants or those with respiratory problems.  The culprit may be pertussis, or whooping cough.  Although considered to be one of the most common vaccine-preventable diseases among young children, the highly contagious infection, caused by the Bordetella pertussis bacteria, has made a comeback in recent years as childhood vaccinations wear off in adolescents and adults.

The pertussis vaccine is routinely given in five doses before a child turns six.  It is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization.   

"By age eleven, most children no longer have immunity from pertussis,” said Dr. Christine Albrecht, a family physician with Lakewood Health System in Staples, MN.  "That is why it is now recommended that kids 11-18 get a booster vaccination, preferably when they’re between the ages of 11-12.  Over the past several years, a vaccination has been available that combines your tetanus booster with the pertussis booster.  Most adolescents need their tetanus vaccine at this time as well.” 

The U.S. Centers for Disease Control recommends that adults who expect to have close contact with an infant younger than 12 months should get the booster as well.  The vaccination should also be considered for adults who have respiratory diseases such as asthma and emphysema as well as for those who have a weakened immune system.  Healthy adults may consider getting the vaccination when their tetanus booster is due. Vaccination is highly effective and remains the most crucial intervention to protect people from pertussis.

Whooping cough is a disease that affects the lungs.  The pertussis bacteria is spread from person to person through the air on respiratory droplets and attaches itself to the hairs that line the respiratory tract.  This prevents them from working  properly. Dr. Albrecht says its early symptoms are similar to the common cold with a low-grade fever, runny nose and cough.  The infected person then develops a severe cough that can last for six weeks or longer.  The name whooping cough comes from the noise a person makes when breathing in after a coughing spell.  The coughing can be so severe it often can lead to vomiting.

"While whooping cough can make a teenager or adult miserable and cause them to miss work or school, it is rarely serious enough to need hospitalization,” Dr. Albrecht said.  "Unfortunately, if pertussis goes undiagnosed, it can unknowingly be spread to those with asthma or immune deficiencies and to babies who haven’t been fully immunized.”

Infants who become infected with pertussis suffer serious breathing problems and often need to be hospitalized due to complications, the most common being respiratory distress, dehydration and pneumonia.  In rare cases, the disease can cause brain damage, permanent lung damage and even death.

"It’s important to note that few people with pertussis will make the classic whooping sound,” said Dr. Albrecht.  "If a patient is having severe coughing episodes or has been exposed to someone with pertussis, they should see their family doctor.”  Testing should be done on exposed people or people who are thought to possibly have pertussis.  The tests can take several days or even weeks to get results.  Antibiotics, when given early in the course of pertussis, will decrease transmission and can help alleviate symptoms.  It may not always make the symptoms go away faster, but Dr. Albrecht says the treatment will help keep the disease from spreading to others. There are several antibiotics that can effectively treat pertussis.

The last peak of pertussis in Minnesota was in 2005 when more than 1,500 cases were reported.  In 2006, that number dropped to 320.  The Minnesota Department of Health notes it is typical for the disease to peak every three to five years - which means cases of the infection could again be on the rise.  Still, the numbers are significantly less than they were in the 1930’s before routine vaccinations began. Back then, more than 200,000 people became infected in a given year.

"The best advice I can give is to make sure your vaccinations and your children’s vaccinations are up-to-date and avoid close contact with those who are coughing or appear ill,” Dr. Albrecht added.  "Those taking antibiotics for pertussis should stay home for at least 5 days.  If they’re not on antibiotics, they should stay home for at least 3 weeks from when the cough began to prevent exposure to others.”

The Minnesota Academy of Family Physicians is a professional association of approximately 3,000 family physicians, family medicine residents and medical students organized to assist family physicians in providing quality medical care in Minnesota. The MAFP is the largest medical specialty organization in Minnesota and is a state chapter of the American Academy of Family Physicians, one of the largest national medical organizations in the United States with more than 103,000 members.

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